Anthem Provider Newsletter – Missouri February 2024

This month’s featured articles:

Administrative

• Home Health Agency Capabilities Survey
• CAA:Have you reviewed your online provider directory information lately?
• Beginning in March 2024, you can submit Behavioral Health prior authorizations through the Authorization application on Availity.com
• Update: Training for digital requests for additional information (Digital RFAI)

Policy Updates

• MCG care guidelines 27th edition update
• Clinical Criteriaupdates — September 2023

Medical Policy & Clinical Guidelines

• Carelon Medical Benefits Management, Inc. genetic testing code updates

Prior Authorization

• Claims Match Enhancement for Carelon Medical Benefits Management, Inc. Genetic Testing
• Prior authorization requirement changes effective May 1, 2024 

Reimbursement Policies

• New reimbursement policy: Modifier Usage — Facility
• Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility

Pharmacy

• Updated requirements to obtain certain specialty drugs from CVS Specialty Pharmacy
• Specialty pharmacy updates — February 2024
• Expansion of specialty pharmacy precertification list

Quality Management

• Improving Hispanic heart health

HealthChoice Provider Network News – Winter 2024

In this issue

• Claim denials needing medical records
• Corrected claims
• Direct data entry of claims and group numbers
• Fee schedules
• Fee schedule updates
• HealthChoice contact information

The February edition of the Medica Connections is now available for review by opening the attached file.

*Reminder to verify the plan type and location listed

Feb2024Conn – Final

The following topics are covered in this edition.

General News

• Wellness Corner:  Seven ways exercise helps the heart.

Clinical News

• Annual Chart Review coming soon for HEDIS quality reporting

Pharmacy News

• Site of Service drug-infusion program expanded to include Briumvi effective 01/01/2024
• Two preferred biosimilars added to long-acting GCSF drug class effective 01/01/2024
• Medica to add new UM policies for 5 new medical pharmacy drugs effective 04/01/2024

Network News

• Effective 04/01/2024 Medica will implement their annual IFB physician fee schedule updates

Administrative News

• Provider administrative training webinar for February: Claim Appeals, Adjustments and Record Submission.  This is scheduled for February 15th 12:00pm – 1pm CST.  The registration link and additional information can be found on the attachment.

This is a reminder that the current Healthy Blue Medicaid Newsletters can be accessed by following this link:

Provider News

UHC has provided two links that will provide you with additional resources for the 2024 Exchange plans.

This link takes you to an interactive guide that provides an overview of these plans.

UHC Exchange Plans Interactive Guide

This link will take you to the Exchange plan website on UHC.com.

Individual Exchange Plans

Home State Health will be offering a TF-CBTWeb 2.0 training course from 8:30 – 5:00 CT March 21-22, 2024.  There are specific items that need to be completed by March 8th before you can register.  Full details are available by following the link below.  This event also has the potential to provide CE credit.

Home State Virtual TF-CBT Training

Cigna Reimbursement Policy Update – 3D Rendering Billed with 76377

As a result of a recent review, we will administratively, deny Current Procedural Terminology (CPT®) code 76377 as incidental, consistent with the process in place for  CPT code 76376. Denials will affect the claim line only and include administrative appeal rights.

We will update the Omnibus Reimbursement Policy (R24) to reflect this change. This update is effective for dates of service on or after April 14,
2024.

NHC Advantage Updates – January 2024

As part of our ongoing commitment to simplify and improve payment transactions for your business, NHC Advantage is offering more choice in payment methods.  Recent feedback from our network indicates quicker reimbursement and more efficient payment reconciliation are high priorities for our providers, and we’re excited to offer additional payment solutions.

January 2024, NHC Advantage will partner with Change Healthcare and ECHO Health, Inc. to provide these new electronic methods. Many of our providers already work with Change Healthcare today.

Please click on the attachment to review these new payment options as well as an announcement regarding an upcoming System Migration.

The January 2024 Providers Newsletter for Healthy Blue Medicaid is now available to view.  The full newsletter can be viewed by following the link below.

This month features a review of some of the digital tools they offer and a review of Provider Pathways.  Also featured is a review of prior authorization requirements that go into effect 03/01/2024 for codes J1411, 20979, A7025, E0692 and E0693.

2024 Provider Newsletter

Healthy Blue newsletter – Jan 2024

Cigna Healthcare continues to leverage the power of technology and data to accelerate its transition to fully adopt digital-only ID cards by 2025. This approach to digital ID cards is next step in our journey to offer more digital-first solutions for our customers and providers.

What this means to you
Digital ID cards are not new for Cigna Healthcare or the industry overall. Over the past several years, you may have noticed patients starting to present their ID cards to you in a digital format – typically on their phone from the myCigna® app or from the myCigna.com® website. This experience for you and your front-office staff should not change.

However, you may start to see more patients who have a digital-only ID card. As they do today, your patients will have the option to:

• Share their digital ID card image on a phone screen in the office
• Relay the information verbally over the phone to pre-register for their appointment
• Upload the digital ID card image to your health portal
• Email the digital ID card image directly to your office from the myCigna app
• Print a copy of their digital ID card and share it with your office

Importantly, please note the digital ID card will look the same as the physical ID card does today and will contain the same benefit information.

Supporting you through this transition
We understand that providers are at varying stages of readiness to accept digital ID cards, and we are committed to making this transition as smooth as possible for you and your office staff.

Please visit our dedicated digital ID card provider website, CignaforHCP.com/DigitalIDCards, which includes a toolkit of information to answer all of your questions on topics such as:

• Verifying benefits and eligibility
• Accessing a patient’s digital ID card
• Procedure code look-up
• Supporting patient communications and guidance